Medicine and The German Jews: A
History by John M. Ephron.

IN PRAISE OF GERMAN RITUAL: MODERN MEDICINE AND THE
DEFENSE OF ANCIENT TRADITIONS.

[CIRP Note: This is an extract of a
small section of Chapter 6: In Praise of Jewish Ritual:
Modern Medicine and the Defense of Ancient Traditions. This
section describes the way in which German Jewish medical
doctors used medical science to develop arguments to defend
and justify the practice of brit milah (ritual
circumcision) and to promote the practice amongst Christians
and other gentiles in the 19th and early 20th
centuries.]

Pages 222-233.

BRIT MILAH

As was the case with the dietary laws and
shehitiah, ritual circumcision was the subject of a
wide-ranging debate in nineteenth-century Germany.117 Circumcision had long been
regarded as the most distintive and separartist of all Jewish
rituals, and the discourse surrounding it went to the heart
of the "willingness" of the Jews to fully participate in the
"act" of being German. The ritual was interpreted as a signal
of the Jews' refusal to rid themselves of their differences,
imprinting on their own male bodies, as an aborginal would
his tribal markings, an ineradicable expression of national
identity. For some, it was circumcision itself that made the
Jew. In the seventeenth century, the Jewish philosopher
Baruch Spinoza declared that "the sign of circumcision is, as
I think, so important, that I could persuade myself that it
alone would preserve the nation forever."118 For figures of the German
enlightenment such as Wilhelm and Alexander von Humboldt,
circumcision was one of those Jewish practices that
"unnecessarily" separated Jews from the rest of society. The
brothers were of the opinion that circumcision should be
either significantly reformed or abandoned altogether.
Expressed at the time of the debates over Jewish emancipation
in the eighteenth century, the von Humbolts' suggestion was
designed to help foster the assimilation of the Jews, and
thus promote the cause of their emancipation.119 In 1831, Heinrich Paulus,
professor of Oriental languages and theology at the the
University of Heidelburg, declared that for Jews to merge
fully with Christians they had to abrogate circumcision, for
unlike the universal act of baptism, it served only to ensure
their isolaton and distinct national identity.120 At the fin-de-siècle, the
opinion that circumcision was the key to Jewish separatism
and national identity was highlighted in one of the most
important anthropological surveys of the Jewish people to
appear in the nineteeth century, Richard Andree's
Ethnography of the Jews. According to the author,
"Circumcision was the pride of the Hebrews and a sign of
their covenant and their separateness from other,
non-circumcised peoples, and that upon which their
nationality was conditioned."121 Further, Andree remarked that the
consequence of circumcision is that it breeds in the
circumcised an "arrogant and haughty" attitude toward the
uncircumcised.

Given that circumcision among German gentiles
was (and still is) extremely rare, Andree's remark went
beyond the mere historical or anthropological to constitute a
negative commentary on what he imagined were the hostile
Jewish perceptions of Germans. In response to such claims,
Jewish physicians downplayed the religious and nationalistic
aspect of the ceremony and instead emphasized its medically
beneficial and thus universalistic qualities, for there was
nothing particularistic about the desire for good health. By
stressing the hygienic advantages of circumcision, German
Jews could offer Germans the benefit of millennial medical
wisdom.122

The offer to share with large numbers of Germans
the alleged pathological advantages of circumcision (and
other Jewish rituals) first took place in 1911, at the
International Hygiene Exhibition in Dresden. Attracting well
over a quarter of a million visitors, the exhibit, and all
that followed until the rise of the Nazis, was akin to a
modern world's fair, but specifically focused on those
positive health and social habits that served to promote good
health among the world's different nations and races. The
Jews manned their own pavilion, and in explaining their
customs and life cyle events, the exhibitors considered their
expository performance an act of generosity rather than a
display of haughtiness.123

In addition to having been the subject of
historical, anthropological, and theological speculation,
circumcision came under legal scrutiny and became highly
regulated over the course of the nineteenth century. While
this was reflective of the general trend of the German state
to enforce ever more control over public health, the desire
to assert authority over the Jewish body had, as we saw with
the burial controversy, an established precedent. Various
state governments and local authorities, often in conjunction
with interested Jewish parties such as physicians and
advocates of local reform, passed legislation and decrees in
their attempts to control Jews, seeking to sanitize in both
surgical and aesthetic terms the procedure and make it
conform as best as possible to German sensibilities. For
example in 1799, the Prussian Oberkollegium sponsored the
preparation of an expert report on the dangers of
circumcision and how they could be avoided. The result was
that in 1819, Prussia promoted the practice of having a
physician attend all circumcisions. This was expanded upon in
1824 when it was decreed that the mohel had to pass an
examination to prove his medical proficiency in treating the
wound. By 1830, the Jews of the Rhineland had reached an
agreement with the state's health officers that only their
officially recognized mohelim would be allowed to practice.
Nevertheless, a physician still had to be in attendance, and
by 1843, noncompliance resulted in a monetary fine of between
5 and 20 taler for the boy's father and from 10 to 50 taler
for the mohel. In 1852 the Jewish community of Hamburg
decreed officially sanctioned rules and instructions for
mohelim, which were later supplemented at a general session
of the mohelim commission of 1900. In 1885, the government of
the district of Wiesbaden offered instruction for mohelim,
and finally by 1887 in Vienna, only physicians were permitted
to perform circumcisions.124

During the 1840s, when Reform Jews held
conferences to discuss issues of religious modification,
debates about the nature and practice of circumcision also
emerged.125 For a minority,
circumcision was a blood ritual, more fitting for what were
deemed savage tribes than for middle-class German Jews. Still
others questioned whether circumcision was itself an absolute
requirement as a sign and marker of Jewish identity. In 1843,
the radical reformer Samuel Holdheim maintained that the
ritual was no longer binding on Jews and that the sign of the
covenant was to be symbolic rather than real. This view was
soundly rejected by the overwhelming majority of German Jews.
But all these were theological, not scientific arguments, and
the majority of Jews were simply not prepared to argue over
the religious nature of brit milah. As a Jewish ceremony it
was a sanctified rite of initiation to be practiced in
perpetuity.

Still, brit milah was under assault and needed
defending. To this end, Jewish communities early on acted in
consultation with state authorities and Jewish physicians to
transform and modernize circumcision by focusing on the
medical aspects of the ceremony. As early as the decree of
1819, wherein the Jews agreed to permit a physician to attend
every brit milah, a creeping concession to modernity was
countenanced. The ceremony became more of a public
performance and was conducted under the "impartial" and
"scientific" eye of the modern physician. To satisfy the
demands of German society, Jews ought to accommodate the
ancient ceremony to the rigors of modern science. They set
out to prove that the operation, with out abandoning its
basic elements, still met the surgical requirements of modern
medicine.

In 1844, a Jewish physician and staunch advocate
of ritual circumcision from Berlin, Joseph Bergson, responded
to the circumcision abolitionists by promoting medical
reforms to make the procedure safer. For Bergson,
circumcision served a religious, symbolic, medical,
political, mythological, and, even quite possibly, a military
purpose.126 In his view, the
sheer antiquity of brit milah, plus its centrality in the
cultural life of the nation, justified its eternal practice.
But to defend brit milah from attack, Bergson proposed the
introduction of modifications in the ceremony.

Because in matters of public health it was "the
duty of the state to protect all its subjects, irrespective
of religion and class," Bergson recommended that circumcision
come under tighter regulation. Precisely because of its
"bloody character," he wanted to see it more closely observed
by both physicians and state medical authorities. Concerned
about the possible abuses that could come from state
intervention in religious affairs, Bergson suggested that the
state tread lightly, embarking with the "greatest possible
forbearance" on a "suitable program of education and
"enlightenment" in order to promote the "physical well-being"
of the child-an advantage to be later served by the state
itself.127

Among the technical changes Bergson advocated
were the abolition of periah by the traditional
method, that is the peeling back of the entire foreskin and
splitting it with a razor sharp fingernail. In order to
expose the glans, and metsitsah, the sucking of the
wound by the mohel to draw out the blood. Claiming that
neither had biblical sanction, Bergson noted that the former
procedure had long been rejected by "rational and ...modern
surgery, a barbaric remnant from medieval field-surgery." In
its stead, he recommended the use of recently invented
scissors and other surgical implements, specifically designed
for the task, and the application of the latest salves,
balms, and elasticized bandages.128 Another Jewish physician who
likewise sought to reform brit milah, D. Salomon, also
recommended a postoperative surgical procedure that involved
stitching the wound, a procedure that was never accepted in
the Jewish world but nevertheless was endorsed by
Bergson.129 According to
Bergson, metsitsah played no prophylactic role whatsoever,
and only increased the chances of transmitting a host of
infectious diseases, including syphilis. It had to go
entirely.130

FIGURE 9. Circumcision implements from the
early twentieth century. The item in the center of the
frame is the shield; it its right is the knife. The cup
is for the performance of the metsitsah, the sucking of
the wound. This act came in for considerable criticism
at the end of the nineteenth century as being
unhygienic and morally dubious. In response, physicians
invented a special glass tube (labelled here as number
2) for metsitsah that was widely used in Germany.
Source: The Jewish Encyclopedia (New York,
1903).

In addition to changes in surgical procedure,
Bergson wanted mohelim to receive fundamental instruction in
anatomy and surgery, claiming that it was "little wonder that
in recent times the opinion had been expressed that the
operation should be taken out of the hands of mohelim and
entrusted to qualified doctors." He lamented the fact that in
antiquity, circumcision among Israelites had been performed
by physicians, whereas it was now performed by the
unqualified!131 This is
reminscent of the call by maskilic physicians in the
eighteen century to remove the control over what Jews did
with their own bodies and hand it over to duly certified
professionals It also recalls a common Haskalah
refrain, echoed by nineteeth-century Jewish social critics,
that idealized and glorified the health care culture of
biblical Israel while at the same time emphasizing the extent
to which modern Jews seemed to have deviated from that
ideal.

With advances in medical knowledge, criticism
and advocacy of circumcision took on a more scientific tone
by the late nineteenth century. The medical profession at
this time expressed two diametrically opposed views of
circumcision: one for and one against. As for the negative
assessment, Jews had long been accused of hypersexuality and
of being chronic practitioners of what a liberal French
cleric, the Abbé Grégoire, called, the
libertinage solitaire.132 Similarly, Jews had long been
linked to the spread of syphilis. Indeed as early as the
fifteenth century, the Genovese ambassador to Charles VIII
called it the "Peste of the Marranos." At the close of the
nineteenth century, because of the association with skin
diseases, antisemitic claims of their immorality, and the
fact that Jews predominated in the nascent medical speciality
of dermatology, Jews played an important role in the medical
literature on venereal disease, and medical opponents of
circumcision rarely failed to draw a causative link between
alleged Jewish concupiscence and sexually transmitted
diseases and the rite of circumcision. One German opponent of
circumcision, a physician from Halle, even claimed that the
majority of patients he treated for gonorrhea were
Jewish.133

The opposite medical assessment was that Jews
were to a large extent protected from a variety of diseases
precisely because they were circumcised.134 Stressing the prophylactic quality
of circumcision, physician-advocates of the procedure
regarded it as a mode of prevention against sexual
malfunction and deviance, sexually transmitted diseases, and
what some physicians called "sexual neuroasthenia."135 Proponents also saw it as a means
to prevent childhood bed-wetting, and prolapse of the rectum,
hernia, and hydrocele, caused by overexertion of the
abdominal muscles in order to overcome impediments to
urination caused by inflammation of the prepuce.136 One Zionist physician, Felix
Theilhaber, held circumcision responsible for the lower
incidence of uterine cancer among Jewish women.137

Much like people today who display a seemingly
insatiable appetite for medical news, the Jewish public at
the turn of the century likewise sought out the latest
information about medical breakthroughs, especially when they
pertained to Jewish pathologies. In a lecture to a Breslau
synagogue in 1902, Jewish physician Carl Alexander told his
audience that there were several diseases that could be
prevented by circumcision, for example, phimosis, a
constriction of the penis opening, which was congenital in 12
percent of boys, and elephantiasis, a chronic enlargement of
cutaneous and subcutaneous tissue, especially of the legs and
scrotum. Alexander also believed circumcision helped stem the
tide of diabetes.138 He and
other Jewish advocates also stressed the humanitarian aspect
of performing circumcision on newborn males because at that
tender age, there would be no memory of either the event or
the discomfort.139

Another physician noted that just as the dietary
laws had a "hygienic basis" in addition to a religious one,
circumcision was to be interpreted similarly. Circumcision
and the attendant prescription of God to "be fruitful and
multiply," he argued, was a holy prescription that for the
Jewish people "led to a curative function." Fulfilling both
requirements was "sure protection against the inclination to
onanism."140 Many Jewish
physicians concurred that circumcision lessened if not
eliminated entirely the instinct to mastubate-an act, they
suggested, that was the end result of a buildup of irritating
secretions under the foreskin.141 The subtext of this observation
was they because they were uncircumcised, it was Christians
rather than Jews who challenged nineteenth-century bourgeois
morality, which condemned masturbation as a vice that in
addition to constituting a complete "loss of control" was
"opposed to all that was manly and virile."142 Here could Jewish doctors turn the
tables on those who had accused the Jews of unbridled passion
and predatory, deviant sexual behavior.

Critics of ritual circumcision were particularly
hostile to the act of metsisah, sucking the wound. For many
Jews, primarily those who had joined the German middle class
and had come to share the culture and aesthetic sensibilities
of that group, metsitsah appeared to be an atavistic,
sexually deviant act.143 Part
of the traditional circumcision ceremony, the practice of
metsitsah was widely condemned throughout the nineteenth
century by medical and lay authorities, Jews and Gentiles
alike. Charging that the practice promoted the spread of a
host of sexual and infectious diseases, the arguments made
against the practice were not confined to Western Europe but
made their way east as well. A commission established in St.
Petersburg in 1891 composed of physicians and "specialists in
Jewish ritual" recommended that in the name of hygiene,
metsitsah and the "tearing off of the lamina interna
by hand" (periah) be abolished.144 A German Jewish physician named
Bamberger also shared some of the more common misgivings
about the procedure, such as the fear that syphilis or
tuberculosis could be spread from child to mohel or vice
versa. In a comprehensive study of brit milah Bamberger
published in 1912, he advocated the use of a glass apparatus
to suck the wound, citing in particular the device designed
by a Professor Pettenkofer of Munich, at the urging of Rabbi
Michael Cahn of Fulda.145 What
Bamberger sought to impress upon his readers was that science
and religion were not only compatible in theoretical terms,
but the religion could be the mother to science's invention.
Working together, they were capable of tackling the problems
confronting the modern Jew, arriving at creative solutions
that permitted ancient tradition to be adhered to.

Technical innovation was not only used to modify
tradition and reconstruct ancient rites in order to harmonize
them with modernity; scientific evidence could even be
deployed creatively to defend all aspects of brit milah,
including the most derided. In 1913, Emanuel Rosenbaum, a
German Jewish physician practicing in Paris, published a
thorough scientific defense of metsitsah. Drawing copiously
on classical Jewish sources, he supplemented these with
evidence from contemporary medical science to endorse the
prophylactic nature of the act.

In defending metsitsah Rosenbaum made two
principal points. The first was the hypocrisy inherent in the
campaign against the practice, in that double standards of
hygiene were employed to make unrealistic demands on Jews.
The goal in the "rational treatment" of a wound, according to
Rosenbaum, is to stave off infection by creating an "aseptic"
environment. But even in a hospital setting the attainment of
asepsis "in the surgical sense is an absolute
impossibility."146 Why he
demanded to know, were Jews required to observe standards of
hygiene in domestic environment that were unobtainable even
in a hospital? Rosenbaum's other method of supporting
metsitsah was to use expert testimony on the treatment of
snakebites. International authorities were quoted, all of
whom testified that standard medical procedure in the case of
such injury entailed sucking poison from the wound. From this
Rosenbaum extrapolated that metsitsah was not only harmless,
but efficacious.147

Rosenbaum directly tackled the issue of
transmissibility of syphilis and tuberculosis
through metsitsah, claiming that not one case had been
reported in the medical literature of contagion having been
spread in this way. At any rate, the mohel's use of
alcohol-"one of the most outstanding disinfectants"-prior to
performing metsitsah ensured an antiseptic oral environment.
And again highlighting double standards, Rosenbaum asked
rhetorically why restauranteurs and hoteliers were not
compelled to disinfect cutlery, crockery, and glassware in
carbolic acid or Lysol after use by their customers if the
threat of orally transmitted infection was so great and so
roundly acknowledged.148 The
fact that they were not required to do only confirmed his
sense that the attack on metsitsah was biased.

Not only did the ceremony of brit milah require
defending, but the mohel had long been an object of scorn.
The mohel, who had no medical training, was clearly seen as
inappropriate. Berlin Jewry had required a physician to
attend each brit milah since the early part of the nineteenth
century, and various reforms had been instituted throughout
the course of the century in order to "medicalize" the
procedure.149 Although
Bamberger defended the mohel, who was attacked most often
because of his inadequate surgical training and because of
the perception that his personal hygiene constituted a threat
to the infant, he did note that rabbis were concerned about
the surgical qualification and dexterity of the mohel,
disqualifying anyone who suffered from "shortsightness,
nervous disorders, shaking of the hands, and internal
diseases." Indicating that change had taken place in the
sensibilities of German Jews, Bamberger observed that "today,
here and there, the religious character [of circumcision] has
been stripped away and it is regarded as a medical
operation."150 To this end,
and in response to various accusations concerning the hygiene
of the mohel himself, Bamberger offered the following
inventory:

Before the [mohel] performs the act, he must
thoroughly disinfect his hands. Today's mohelim
wash their hands in this same warm water they soap
themselves up with carbolic acid or Lysol and use a
brush, especially around the nails. The same happens to
the instruments which are boiled just before their use.
These are: 1. A double-bladed knife, 8-10 cm long; 2. A
metal clamp and forceps; 3. A common pair of tweezers to
fasten the area around the wound; 4. 2-3 bolted tweezers
to squeeze the bleeding; 5. different bandages, plasters,
and swabs-all sterilized; 6. Scissors and a surgical
sewing needle; 7. A glass tube for the metsitsah. In
Hamburg the doctors have put together a 'sterile
first-aid kit for circumcision.' Also the instruments,
which are afixed inside a utensil for boiling, are
sterilized at the scene of every circumcision.151

Here there is no God, no Abraham, no Covenant.
This stark and clinical description of the mohel's
instruments was designed to construct a clean counterimage of
the Jews. Here in Judaism's most elemental rite of passage,
one long derided for its supposed savagery and uncleanliness,
Bamberger sought to demonstrate the antiseptic nature of brit
milah as it was performed in contemporary Germany. Although
the mohel was not a physician, let alone a trained surgeon,
every precaution had been taken to ensure that he upheld the
most stringent rules of modern hygiene. As much as it could
be, the ceremony had been "de-orientalized," indeed
Germanized, tailored to conform to German, not traditional
Jewish notions of cleanliness.152

One of the most important claims made about
circumcision by its opponents in the medical world was that
it was an unnecessary procedure, one that "deformed" a
perfect organ, a view expressed for example by Paul
Ascherson, professor of medicine at the University of
Berlin.153 In stark contrast,
a Jewish physician, S. N. Kutna, declared circumcision to be
an act of bringing about "bodily perfection," the foreskin
being, "in a biblical sense, a defect."154 Jewish countercharges not
withstanding, the accusation of their bodily deformity goes
to the issue of how Jews fit into the ethic of human
physicality is Wilhelmine Germany. Antisemites interpreted
circumcision in political and nationalistic terms. For them,
a deliberately mis-shapen body, such as one that had been
circumcised, was an imperfect body, and an imperfect body
was, by definition, inadmissable into the body politic of the
nation. For example, the 1894 statutes of the fiercely
antisemitic organization, the Deutschbund, claimed that "the
Jew cannot belong to the Deutschbund, nor become eligible by
baptism, because his circumcision harbours his
nature."155 In this radical
assessment, circumcision constituted a permanent taint that
prevented the integration of Jews into German society.

For many, the separatist rite of brit milah
distinguished Jews from Germans in the most tangible way,
permanently impressing upon Jews a mark of national
otherness. Thus circumcision was to the notion of race, in
that for antisemites it too was indelible. The Jew, because
he was circumcised, would remain forever "physically" Jewish,
even if he had converted to Christianity.

It was not only brit milah but the entire array
of Jewish customs and ritualistic behavior that contributed
in a sense that the Jews were fundamentally different from
the Germans. Even those Germans who were well disposed to the
integration of Jews into German society were quite convinced
that the social product of the performance of Judaism's most
important rites was Jewish separatism.

In response Jewish physicians in modern Germany
enlisted the help of medicine to answer crises in and
challenges to Judaism and Jewish culture itself. Sometimes,
for example, in the case of the methods of animal slaughter,
the challenge was driven by blatant anti-semitism. On other
occasions, such as with the discussions of the ritual bath or
the dietary laws, the agitation for reform could come from
within as well as from without. Whatever the case, the
challenges were generally the product of the Jewish encounter
with the modern secular world. And, in what is a wonderfully
intricate paradox, German Jews were able to use one of the
defining characteristics of the modern
age—science—to reinforce their Jewish identities,
justify their ancient traditions, and help them navigate
their way through the turbulent waters of modernity.

Leopold Zung,
Gutachten über die Beschneidung (Frankfort am
Main, 1844); Jacob Katz, "The Struggle over Preserving the
Rite of Circumcision in the First Part of the Nineteenth
Century" in his Divine Law in Human Hands: Case Studies
in Halakhic Flexibility (Jerusalem: Magnes Press,
1998), 320-356; and Lawrence A. Hoffman, Covenant of
Blood: Circumcision and Gender in Rabbinic Judaism
(Chicago: University of Chicago Press, 1996), 2-9.

In fact, in 1878 a Jewish
doctor named Rosenzweig proposed that a national law be
passed purely out of sanitary considerations that would
have required German Christians be circumcised. Andree,
Volkskunde der Juden, 163.

George L. Mosse,
Nationalism and Sexuality: Respectability and Abnormal
Sexuality in Modern Europe (New York: Howard Fertig;
1985), 11; and George L. Mosse, The Image of Man: The
Creation of Modern Masculinity (New York: Oxford
University Press, 1996), 27, 60-62.

For the most
comprehensive treatment of see Jacob Katz, "The Controversy
over the Mezizah: The Unrestricted Execution of the
Rite of Circumcision," in his Divine Law in Human
Hands, 337-402.